How to Create or Edit Payers

How to Create a Payer

1. Go to Settings > General Settings > Financial Settings

2. Once you have clicked on Payers select the option "ADD PAYER"

3. After clicking on "Add Payer" fill out the form according to your payer's information and click "Save"

How to Edit a Payer

Go to Settings > General Settings > Financial Settings
Select a payer in the table and click Edit

How to Use the Payer Settings

Payer name. You can type in whatever you want, but if you want to use our integration with Change Healthcare (optional), you must choose a payer from the dropdown menu. Those are taken directly from their website.
Payer ID. This will be automatically filled out if the name of a plan was selected from the dropdown menu that appears in the title field.
1. You can search payer IDs directly from Change's website here: https://connectcenter.changehealthcare.com/#/site/payers
2. You can search payer IDs directly on Availity's website here: https://essentials.availity.com/static/public/onb/onboarding-ui-apps/payer-list-ui
CPID (Claim Payer Identification). The CPID is another ID that will be automatically filled by the system.
1. You can search for CPIDs and actual payer IDs directly from Change's website here: https://connectcenter.changehealthcare.com/#/site/payers
2. Availity payers don't have a CPID.
Plan type. Please contact your biller or your payer to verify what is the correct option.
Nickname. This is an optional field used to help you quickly and easily identify this payer throughout the system.
Visit Verification section.
1. CR Essentials Advanced Visit Verification + GPS (EVV Compliant). This option will run verifications after visit is completed and flag it if something is missing. This will also verify GPS location of where the therapist clocked in/out and check if it matches with the scheduled location of the visit. See details
2. CR Essentials Advanced Visit Verification. This option will run verifications after visit is completed and flag it if something is missing. No GPS verification. See details
3. Use Sandata verification. Some payers require Sandata Electronic Visit Verification (EVV).
4. Use mobile visit timer. This option is on by default. This causes the system to log both the scheduled time of a visit versus the actual time. Actual being the time when the therapist clocked in and out from the visit. If this checkbox is off, the visit will be marked as complete using only scheduled times.
Services (Modules). Currently, there is only an ABA module is our platform but there might be more in the future.
Payer Contact Information
1. This information is only needed if you are using our integration with Change Healthcare or Availity. You will need to enter if you don't have the information handy, you would find that on the contract or on the payers’ website.
Claim Settings
1. No Clearinghouse. Select this option when you are planning to do your billing manually or you will be using a 3rd party service to do your claim billing.
2. Change Healthcare. This activates the connection between your CR Essentials account and your Connect Center account, allowing you to use the integration.
3. Availity. Select this option if you are planning to integrate with Availity. You can create a free account directly in: https://www.availity.com/essentials/
4. Private Payer. This is meant for 100% private pay clients. Clients that are paying out of pocket. This would create a draft of an invoice to bill directly to the client. (If this option is selected, please uncheck any clearinghouse option).
Send Referring o Ordering Provider. You can send either or none.

How to Use the Advance Claim Settings

1. Claim filing code. Please contact your biller or your payer to verify what is the correct option.

2. Split Claims by Rendering Provider. If you have several visits selected when creating claims, a different claim will be created for each rendering provider (therapist).

3. The next 4 are only needed when connecting with Availity. Copy these exactly:

Interchange Sender ID (ISA06): AV09311993
Interchange ID Qualifier (ISA07): 01
Application Sender’s Code (GS02): 5010
Application Receiver’s Code (GS03): 030240928

Custom submitter ID. Sometimes, payers will provide the company a submitter ID which is meant to replace the EIN of the company at the claim level. This usually, only happens with some BCBS payers.
Fill out EPSDT field (Y). EPSDT stands for Early and Periodic Screening, Diagnostic, and Treatment, a mandatory Medicaid benefit for youth under age 21. Some payers require this on.
Do not send client responsibility line. Sometimes, a payer may deny claims if client responsability field is sent as 0. If this checkbox is on AND client responability is 0, the system will just not send that line.

Send Fields: All this information here is to send any extra information on the CMS 1500 form that is automatically filled out and sent to the clearinghouse.

Billing Provider - This is company level information on the claim (Field 33)

1. State License Number.

2. Provider ID. An ID that is provided by the payer specifically for the company.

3. Taxonomy Code. To add this: Settings>General Settings>Company Settings.

4. Custom Company Address as Service Location. You can select other company addresses. To add one go to Settings>General Settings>Company Addresses.

In CMS 1500, send Facility ID and original rendering provider’s NPI on Field 19. Some payers require field 19 to hace a facility ID that is entered on the addresses tab in the client's profile and also the original rendering provider NPI when it is being overriden by the supervisor.
Override Billing Provider. You can override billing provider with other billing providers you have created. You can add other billing providers in Settings>Financial Settings>Other Financial Settings and create additional billing providers as individuals or organizations.

Rendering Provider - This is individual level information on the claim (Field 24J)

Bill only under company (no rendering provider). Does not send any rendering provider. Rarely, some payers may need this.
State License Number. To add this go to the therapist profile and click on Edit.
Provider ID. To add this go to the therapist profile and click on Edit.
Taxonomy Code. To add this: Settings>General Settings>Therapist Types.
Rendering Provider in Header. If the rendering provider is the same in all service lines of a claim, include the therapist's details in the rendering provider field (electronic claim only).

Como crear y/o editar pagadores

1. Vaya a Settings > General Settings > Financial Settings

2. Una vez que haya pulsado sobre Pagadores seleccione la opción "ADD PAYER"

3. Después de hacer clic en "ADD PAYER", rellene el formulario con los datos de su pagador y haga clic en "Save".

Campos:

1. Título. Puede escribir lo que desee, pero si desea utilizar nuestra integración con Change Healthcare (opcional), debe elegir un pagador en el menú desplegable. Estos se toman directamente de su sitio web.

2 . Payer ID. Esto se completará automáticamente si se seleccionó el nombre de un plan en el menú desplegable que aparece en el campo de título. Esto mostraría el ID de pagador de salud (CPID) y no el ID de pagador que está acostumbrado a ver. Si escribe cualquier otro título, permanecerá en blanco. Puede buscar CPID e ID de pagador reales directamente desde el sitio web de Change aquí: https://connectcenter.changehealthcare.com/#/site/payers

3. Tipo de seguro. Por ahora, se rellena previamente como "profesional" cuando selecciona un pagador en el menú desplegable. De lo contrario, permanece en blanco.

4. Apodo (opcional). Puede ingresar un apodo para este pagador si lo desea.

5. Código de presentación de reclamos. El código indicador de presentación de reclamaciones se utiliza para identificar si el pagador principal es Medicare u otro pagador comercial. Esto solo es importante si está utilizando la integración con Change Healthcare. Si es así, seleccione el código de presentación correcto en el menú desplegable. Si no sabe cuál es el correcto, comuníquese con su emisor de facturas o su pagador para seleccionarlo. Si no está utilizando la integración, puede dejar este espacio en blanco.

6. De los pasos 6 al 15. Todas estas opciones aqui son para enviar cualquier informacion adicional en el formulario CMS 1500 que se completa automaticamente y se envia a la camara de compensacion. Dependen de los requerimientos de cada uno de los pagadores.

Enviar codigo de taxonomia del proveedor de facturacion. Algunos pagadores requieren que se envie el codigo de taxonomia en el archivo CMS1500/837p (esto debe agregarse en la pagina de tipos de terapeutas)

Enviar numero de licencia estatal del proveedor de facturacion y Enviar numero comercial del proveedor de facturacion > Estas opciones se pueden ingresar manualmente aqui, todo lo que necesita hacer es marcar la casilla junto a la opcion, y el campo se habilitara para ingresar los datos necesarios.

Enviar numero comercial del proveedor de renderizado >

Enviar numero de licencia estatal del proveedor de prestacion > Debe ir al perfil del terapeuta y hacer click en editar, ahi encontrara la opcion para ingresar esta informacion.

16. Conectar a. Esto debe seleccionarse si está utilizando integraciones. Aquí hay 2 escenarios:

No desea que su resumen de facturación se integre con nada, por lo que deja la opción sin seleccionar.
Utilizará la integración de Change Healthcare para que pueda convertir las visitas completadas en reclamos para el pagador en el resumen de facturación, en cuyo caso selecciona la opción "Clearinghouse."

17. Servicios (Módulos). Actualmente, hay dos módulos que se ofrecen a través de nuestra plataforma. El módulo ABA es nuestro principal y un módulo de salud mental comunitaria (que solo se puede activar si se solicita al servicio de atención al cliente).

18. Información de contacto del pagador. Es necesario ingresar la dirección y el número de teléfono del pagador si se usa la integración con Change Healhcare.